Infection Control Can Prevent Paralysis

When the curriculum for my advanced degree in preventive medicine was first offered at The Ohio State University, the material was highly focused on infection control, including in hospitals and the general public health realm.

The material has saved many individuals from serious infections and even death, but it may also help prevent the paralysis caused by a mysterious condition known to us as acute flaccid myelitis.

A Troubling Paralytic Disease

Throughout the month of October 2018, media outlets reported a troubling increase in U.S. cases of acute flaccid myelitis (AFM).

This condition is similar to poliomyelitis, which was once called “infantile paralysis.” Polio was eradicated fully from America in the 1979, but AFM produces a similar paralysis in children and a few adults, although it is not caused by the same virus (poliovirus).

While medical experts and the news media reported a scrambling among professionals to find the causes of AFM, The Ohio State University looked more closely, as did the Centers for Disease Control and Prevention (CDC).

Minneapolis MN: young Marvin Goldstein, an infantile paralysis patient, shows control of extensor muscles of the back at a class for technicians and doctors conducted by Sister Kenny, who successfully treated polio. | Source

An old way of treating paralysis through exercise. | Source

What Does Acute Flaccid Myelitis Do?

AFM affects the spinal cord—a bit in the manner of multiple sclerosis, which causes scarring in spots in the spinal cord and the brain. AFM causes inflammation of motor nerves (neurons) and usually within gray matter, which can lead to partial or full paralysis. It may be an autoimmune disease like MS, and may be associated with some trigger stimulus, but that idea is still in debate.

Symptoms of AFM

AFM is characterized by loss of muscle strength and control. You may notice:

Muscle weakness and loss of muscle tone

Delayed reflexes

Drooping eyes and mouth

Difficulty moving eyes and eyelids

Difficulty swallowing

Slurred speech

Respiratory problems (typically late in disease progression)

While it occurs most frequently in young children, largely per-schoolers, a few adults succumb.

Resulting paralysis is said to be "quick-evolving," developing in about 4–7 days. However, in 2018, we are hearing from distraught mothers telling us that their child goes to bed with a cold and awakens with paralysis of at least one limb, and in one case, the entire body below the neck.

Although AFM may mimic other infections of the central nervous system, it is different in that the infection seems to occur cyclically with spikes in even-numbered years. To date, we do not know why, but because the infection rate is only about 1/1,000,000 people overall, government and private funding for related research are not likely to increase.

Explaining the Cyclical Nature of the Disease

No research has been done as of Autumn 2018 into the two-year life cycle of insects that might somehow be associated with AFM disease. These insects may be the vectors that carry infectious organisms like bacteria and viruses and include:

Two-year-cycle budworm: Choristoneura biennis, native to Eurasia. This insect eats pine trees in Western Canada and is not likely to be at fault.

Two-year cicada: This is a possibility. In addition, many cicadas have a one-year life cycle but appear in massive quantities at intervals, such as two years or longer.

Species Heteroptera:Aradus cinnamomea. This insect looks like a tick and some ticks carry diseases. This one is called the "pine flat bug", native to the Eastern Hemisphere at least from the UK across northern Europe to Siberia. It eats wood and spreads quickly if an infested woodpile is moved.

Species Lepidoptera: Dozens of different insects like butterflies and moths. A few are native to North America and some are native to both North America and Siberia. Could butterflies carry disease(s) that harm our children?

Species Diptera:Chironomus anthracinus. This is a fly native to the Eastern Hemisphere. Some flies carry diseases.

Species Hymenoptera:Neodiprion sertifer, the pine sawfly found in North America since 1925.

Species Coleopter:Saperda populnea, a beetle found in North America and elsewhere.

Insect related spread of infections is an ongoing research concern at The Ohio State University and we may see some work there in the area of AFM in the future.

Possible Causes of Acute Flaccid Myelitis

A lot of static from speculation has surrounded AFM since medical concern arose in 2012. Proposed causes for the disease have included:

Poliovirus (quickly eliminated as a possibility)

Various childhood vaccines (eliminated quickly as a cause)

Avian flu

Bed bugs as carriers. This suggestion came from some in the non-medical population of Central Ohio and no resulting research has involved bed bugs.

Coxsackievirus A16: Found by CDC in only four out of 430 cases. This is not enough to prove a correlation.

Non-Polio Enterovirus Type EV-A71: Found in only four out of 430 cases.

Non-Polio Enterovirus Type EV-D68: Found in only four out of 430 cases. However, a large outbreak of enteroviral respiratory infections in America occurred during the time that AFM hit hard in 2014. Additionally, a study in 2018 by A. Dyda, et al. states: "The incidence of EV-D68 infections is increasing world-wide...Application of the Bradford Hill criteria supported a causal relationship between EV-D68 and AFM." While this is true, we may or may not have a cause in EV-D68, although some researchers at OSU believe so. The relationship between EV-D68 and AFM is pending further investigation.

West Nile Virus: Believed to be a cause by the California Department of Public Health.

Note: From 2014 though 2018, at least 90% of patients suffered cold-like symptoms before acquiring AFM—either a respiratory infection, a fever, or both.

Few Markers Found for Causes

Whatever the cause(s) of the disease, a consensus among researchers at CDC, OSU, and other sites seems to be that AMF can be passed through feces and/or blood, and can be detected in sputum and spinal fluid. Tears, nasal mucus, saliva, and blister fluids may also contain a related infectious element. However, the infectious elements for which these tissues are tested has turned up little evidence for a cause.

Additional tissue specimens for testing included flash-frozen sections of brain/spinal cord tissues (both gray and white matter), heart, lung, liver, kidney, and other organ tissues. New testing may be developed.

CDC will conduct routine testing and typing of CSF (cerebrospinal fluid), respiratory specimens and stool for enterovirus/rhinovirus, and poliovirus testing of stool specimens to rule out the presence of poliovirus. Additional testing protocols are being developed...

— CDC, as of November 20, 2018

How Is Acute Flaccid Myelitis Treated?

To date, the paralytic symptoms of AFM are treated with such methods as blood plasma replacement and immunoglobulin IV administration. Some patients recover to varying degrees, but others do not.

Until better treatments are discovered, prevention is key. It is best to practice infection control, including:

Wash your hands often and avoid people who are ill with respiratory illnesses. If you or children you have are sick, stay/keep them home. When sick around others, please cover your coughs and sneezes and wash your hands afterward. Use disinfectant wipes as well. Use disposable tissues instead of cloth handkerchiefs and discard them quickly.

If you change diapers of either children or adults, please wash your hands thoroughly before touching anything else, including your own face, eyes, nose, or mouth. In the bathroom, keep the toilet bowl lid closed when not in use and clean the toilet regularly, followed by thorough hand washing.

Do not lick your fingers and use them to turn pages in books in libraries and other public venues—even at home. Do not use saliva-covered fingers to open plastic grocery store bags or count money. Do not use saliva-covered fingers to smooth out anyone's hair or wipe smudges away. Remember that you may not be sick, but you may still be a carrier, infecting others in the manner of Typhoid Mary.

Do not sit on, allow anyone else to sit on, or change diapers on kitchen counters, dining room tables, etc. Infectious elements pass (are shed through) one's clothing onto these surfaces. Use different cloths or paper towels to clean chair seats and table tops/counter tops. In fact, in one of my local suburbs, this is the law for restaurants and other eating/drinking places.

Do not drink from the same glass or cup or eat off the plate of another person, even a communal cup at church communion.

Do not taste dishes you are cooking and put the spoon back into the food.

Do not double-dip (dunk food into a dip at a party and stick the same piece of food back into the dip).

Instead of shaking hands with anyone, use the "fist bump." This includes friends and relatives.

Do not purchase wood or plastic cutting boards from thrift stores and flea markets. They may be already-used and harbor infectious elements in the accumulated cuts on the surface—even bleach will not eradicate them all. After purchasing new boards, make sure to prevent cross contamination by reserving one board for vegetables (and possibly beef or pork, but to be safe I have another board for those two) and a separate board for chicken (all fowls).

If you are pregnant, immunocompromised, or are a senior citizen, ask your doctor how best to be safe from infections.

If you have other useful advice in this vein, please share them with us in comments below.

Pattern of AFM Cases

Most cases of this disease occur from August–October and spike during even-numbered years.

Notice the spikes in infection numbers in alternate years: 2014, 2016, and 2018 as of August of that year. By the end of October, 2018 the numbers were much higher. | Source

Infection Statistics for AFM: 2012–2018

Year

Number of U.S. Cases

Number of Deaths

2012

10 cases in California

?

2013

Unknown, but a total of 59 from 2012 through 2015 in California

?

2014 (August 1–December 31)

120

2 adults, ages 55 and 73

2015

22

?

2016

149

?

2017

33

At least one child, acknowledged by CDC.

2018 (January 1–December 21)

189

At least two children, reported by parents on social media.

Data comes from the Centers for Disease Control and Prevention.

Facebook group for parents of children with AFM: "A.F.M.-Acute Flaccid Myelitis Awareness, Our Generation's Polio" https://www.facebook.com/groups/afmawareness/

Hope for a Cause and Cure From Government Health Agencies

The U.S. Epidemic Intelligence Service (EIS) has been called onto the AFM case by the CDC in 2018.

Concerned parents of children who have died from AFM or are suffering the debilitating symptoms of the disease may feel led to contact new personnel assigned to work on infections transmitted from animals to humans.

The EIS Class of 2018 includes new two-year fellowship personnel who may find themselves investigating the condition or stumbling across pertinent information in the course of other investigations. These people are:

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Questions & Answers

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sending

Dora Weithers

8 months agofrom The Caribbean

Thank you for this comprehensive discussion on this disease. It seems we have to check regularly for new diseases. Not long ago, I read that the bites of bed bugs were harmless, now according to this study, they may be carrying AFM. Thanks for including all the warnings and preventative measures.

AUTHOR

Patty Inglish MS

8 months agofrom USA and Asgardia, the First Space Nation

@FlourishAnyway - Communal cup in families or church is kind of a bad idea, isn't it, in these days of increasing numbers of infections hitting us? I also hate it when I see someone cook dinner for others, eat part of his/her food and put the rest back into the soup pot and serve second helpings out of it! I hesitate to go to potluck meals anymore.

Thanks for your thoughts! I wish you increasing good health and hope some of the newer treatments being designed will finally be a cure for MS.

FlourishAnyway

9 months agofrom USA

This was really surprising and sad information, but what I appreciated so much is that you provided much-needed, practical action items for prevention. These things certainly cannot hurt and may also assist in preventing spread of other illnesses like the common flu.

I'm so glad you included the part about not drinking from a communal cup. I've long been disgusted at that practice and don't know why people would do it in this day and age.

I have MS so with a compromised immune system I was unlucky enough to come down with the H1N1 early on during the 2009 pandemic. Both experiences have made me aware that one's health can change in a hurry. It's especially sad to think about the impact upon children.

I hope experts are looking at the situation from a "big data" perspective as well as from a scientific perspective. All resources that are possible need to be marshaled early on, before more lives are impacted.

This is an excellent article about this disease. I certainly hope researchers will further their understanding about the cause of this disease, and treatments. Prevention does seem to be a key tactic.

AUTHOR

Patty Inglish MS

9 months agofrom USA and Asgardia, the First Space Nation

@Linda - Thank your for reading and commenting on this topic. I think first, a researcher with time (but no supporting money for AFM research, unhappily) needs to look at spike increases of other infections and conditions in 2014, 2016, and 2018; then look for spike increases in single-celled entities and wildlife populations of mammals, birds, insects, fish, etc. during those years. We may some connections.

Some masters and PhD candidates at OSU may be looking into these elements right now, so I too hope we arrives at some answers sooner rather than later.

Thanks for writing your science-related articles that bring good knowledge to readers. It's an important contribution.

Linda Crampton

9 months agofrom British Columbia, Canada

Thank you very much for creating this informative and useful article, Patty. I have read a little about this horrible disease but am glad that I've learned a lot more by reading your article. I hope researchers discover the cause or causes of the disease soon.

AUTHOR

Patty Inglish MS

9 months agofrom USA and Asgardia, the First Space Nation

@Mary Horton - The more I hear about viral and bacterial diseases, the more I think about taking precautions. It is very sad how young children are sickened by whatever the cause of AFM is. Thanks for posting a response!

Mary Norton

9 months agofrom Ontario, Canada

Thank you for posting this here. I have to admit my ignorance about this. Although I do most of your recommended precaution, it is good to be reminded of how important these are.

AUTHOR

Patty Inglish MS

9 months agofrom USA and Asgardia, the First Space Nation

That makes me smile.

mckbirdbks

9 months agofrom Emerald Wells, Just off the crossroads,Texas

Hi Patty - Yes, we already know enough about concrete and blockheads for that matter.

AUTHOR

Patty Inglish MS

9 months agofrom USA and Asgardia, the First Space Nation

Hi Mike, and Happy Thanksgiving!

I recently read two news articles by grieving mothers who had just lost their young sons to AFM. It is heartbreaking and these two families feel that the federal government is hiding the fact that some patients have died from this disease.

Finding a cure for these types of disorders is much more important than building a border wall, many of us believe.

mckbirdbks

9 months agofrom Emerald Wells, Just off the crossroads,Texas

Hello Patty - What a serious subject. The precautions list seems like good solid advice. I hope this presentation was brought on by curiosity and not first (or second) hand experience.

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